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PubMedDate not supplied

The Indian Health Service approach to alcoholism among American Indians and Alaska Natives.

The transfer to the Indian Health Service (IHS) of 158 alcohol treatment programs that had been administered by the National Institute on Alcohol Abuse and Alcoholism began in 1978. Today, approximately 300 alcohol and substance abuse treatment programs offer services to American Indians, among them primary residential treatment, halfway houses, outreach, and aftercare. This system provides a national network upon which additional activities may be established. Along with increasing its attention to health promotion and disease prevention, the IHS has moved toward the prevention of alcoholism. A variety of preventive programs are in place that emphasize improved self-image, value and attitude clarification, decision-making, and physical and emotional effects of alcohol and substance abuse. Many begin as Head Start programs and continue through adulthood. In 1986, after consulting with both academic and tribal experts, the IHS devised a strategic plan for alcoholism control that stresses comprehensive care and prevention activities; it serves as a guide for further program development. The Secretary of Health and Human Services created a Task Force on Indian Alcoholism in 1986 to serve as a coordinating body for activities carried out by the IHS and other agencies and units of the Department. Passage of the Anti-Drug Abuse Act in 1986 added resources for the development of adolescent treatment centers and, more importantly, for community-based pre- and post-residential care for youths and their families. Concomitant with these initiatives have been several instances of increased attention by various tribes to the problem of alcoholism. The IHS strategic plan, together with the Secretary's initiative, the Anti-Drug Act, and tribal actions, has added substantial momentum to efforts directed at controlling alcoholism among American Indians. Although the mortality rate from alcoholism is about four times greater for the American Indian population than for the entire U.S. population, it decreased from 54.5 per 100,000 population to 26.1 between 1978 and 1985-a reduction of 52 percent.The philosophy of the IHS in emphasizing prevention of disease and promotion of wellness provides an opportunity for continuing the considerable progress already made. The critical and decisive role played by the Indian communities themselves will determine whether ultimate success can be achieved.

Adolescent↗
PubMed1989

Psychiatric investigations among American Indians and Alaska natives: a critical review.

This review of psychiatric investigations among Native Americans opens with a discussion of the dominant theoretical perspectives in psychiatric anthropology in order to provide an analytic framework with which to assess the substantive findings of researchers in the field. Studies of culture-specific disorders, service utilization and patient population studies, psychiatric epidemiological studies, and studies designed to test the validity of certain diagnostic instruments are scrutinized for evidence of the nature of the role of indigenous cultures in the manifestations of psychiatric disorders among these populations. The review reveals that a universalist theoretical perspective, which tends to obscure the role of local interpretations in the phenomenology of psychiatric illness, dominates this field of inquiry. Nonetheless, evidence has accumulated which indicates the importance of native understandings for a more reliable and valid explanation of the nature of mental disorder among these peoples. The inadequacies of our current knowledge are examined and suggestions for directions in future work are presented in the concluding section. Recommendations include the direct investigation of the local meanings of the signs, symptoms, and syndromes of Western psychiatry; the concentrated search for potentially unique and powerful local signs of distress; and the study of the culturally-constituted social processes of illness.

Anthropology↗
PubMedDate not supplied

Public education strategies for delivering breast and cervical cancer screening in American Indian and Alaska Native populations.

A 1993 amendment to the authorizing legislation for the Center of Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program allows direct funding to tribal organizations and urban Native health centers. This study examined tribal programs' implementation of the public education and outreach component utilizing a multisite case study design implemented in partnership with tribal programs. Data were collected from 141 semistructured interviews with key informants and 16 focus groups with program-eligible women. Innovative strategies built on native iconography and personal encounters have encouraged participation and made the programs culturally relevant, providing insights for other communities with little experience in providing early detection services.

Breast Neoplasms↗
PubMed2005

Bone mineral density of American Indian and Alaska Native women compared with non-Hispanic white women: results from the Women's Health Initiative Study.

OBJECTIVE: To compare bone mineral density (BMD) of American Indian/Alaska Native (AI/AN) women with that of non-Hispanic white women. DESIGN: This cross-sectional study compared mean BMD between AI/AN women and a random sample of non-Hispanic white women matched on geographic region in the Women's Health Initiative Study, a prospective study of postmenopausal women. We analyzed baseline BMD measurements for the total hip, spine, and whole body from 139 AI/AN women and 1,431 non-Hispanic white women. RESULTS: Unadjusted mean spine and whole body BMDs were not significantly different between the two races. Controlling for age, education, and hormone therapy use, adjusted mean BMD was similar by race among women who were underweight, normal, or obese. We found a significant interaction of race by body mass index on spine (P = 0.003) and whole body (P = 0.0003) BMD; thus, analyses were stratified by body mass index. Overweight AI/AN women had slightly lower adjusted mean whole body and spine BMD than overweight non-Hispanic white women (whole body: 0.97 vs 1.03 g/cm, P = 0.02; spine: 0.96 versus 1.03 g/cm, P = 0.001). Among extremely obese (body mass index: > or =40.0 kg/m) women, adjusted mean total hip BMD was higher in the AI/AN women (1.07 vs 0.97 g/cm, respectively, P = 0.03). CONCLUSIONS: Overall, AI/AN and non-Hispanic white women had similar BMDs. This study suggests that extremely obese AI/AN women may have higher BMD at certain skeletal sites compared with extremely obese non-Hispanic white women. However, these results need to be confirmed by additional research.

Absorptiometry, Photon↗
PubMed1992

An overview of mental health services for American Indians and Alaska Natives in the 1990s.

Native Americans appear to be at higher risk than other U.S. ethnic groups for mental health problems, including depression, substance abuse, domestic violence, and suicide. Despite recent increases in the federal budget for mental health services for Native Americans, less than 50 percent of the estimated need for ambulatory services is being met. Initiatives to improve the quantity and quality of mental health services for Native Americans in the 1990s include development of a national mental health plan, increased technical assistance to Native American communities, additional training and research, and continued attention to standards that promote high-quality, culturally relevant care. Tribes themselves are seen as the most appropriate locus for initiation of programs for preventing emotional problems in their communities.

Community Mental Health Services↗
PubMed2003

Prevention and treatment of type 2 diabetes mellitus in children, with special emphasis on American Indian and Alaska Native children. American Academy of Pediatrics Committee on Native American Child Health.

The emergence of type 2 diabetes mellitus in the American Indian/Alaska Native pediatric population presents a new challenge for pediatricians and other health care professionals. This chronic disease requires preventive efforts, early diagnosis, and collaborative care of the patient and family within the context of a medical home.

Adolescent↗
PubMed2006

Interpersonal violence in the lives of urban American Indian and Alaska Native women: implications for health, mental health, and help-seeking.

OBJECTIVE: We surveyed American Indian/Alaska Native (AIAN) women in New York City to determine the prevalence of 3 types of interpersonal violence among urban AIAN women and the behavioral health and mental health factors associated with this violence. METHODS: Using a survey, we questioned 112 adult AIAN women in New York City about their experiences with interpersonal violence, mental health, HIV risk behaviors, and help-seeking. The sampling plan utilized a multiple-wave approach with modified respondent-driven sampling, chain referral, and target sampling. RESULTS: Among respondents, over 65% had experienced some form of interpersonal violence, of which 28% reported childhood physical abuse, 48% reported rape, 40% reported a history of domestic violence, and 40% reported multiple victimization experiences. Overwhelmingly, women experienced high levels of emotional trauma related to these events. A history of interpersonal violence was associated with depression, dysphoria, help-seeking behaviors, and an increase in high-HIV risk sexual behaviors. CONCLUSIONS: AIAN women experience high rates of interpersonal violence and trauma that are associated with a host of health problems and have important implications for health and mental health professionals.

Adolescent↗
PubMed2006

Identification of American Indian and Alaska Native veterans in administrative data of the Veterans Health Administration and the Indian Health Service.

We sought to determine the extent to which the Indian Health Service (IHS) identified enrollees who also use the Veterans Health Administration (VHA) as veterans. We used a bivariate analysis of administrative data from fiscal years 2002-2003 to study the target population. Of the 32259 IHS enrollees who received care as veterans in the VHA, only 44% were identified by IHS as veterans. IHS data underestimates the number of veterans, and both IHS and VHA need mechanisms to recognize mutual beneficiaries in order to facilitate better coordination of strategic planning and resource sharing among federal health care agencies.

Data Collection↗
PubMed2004

Developing a plan for measuring outcomes in model systems of care for American Indian and Alaska Native children and youth.

The Circles of Care initiative emphasized the importance of developing an outcomes measurement plan that was consonant with the model system of care as well as community values and priorities. This analysis suggests that the Circles of Care grantees achieved this key programmatic objective, but that a major constraint was the tendency of funders, including the Substance Abuse and Mental Health Services Administration (the funder of Circles of Care), to mandate their own outcomes measurement plans. Funders are encouraged to balance their needs for commonality of measures across programs for their own evaluation purposes with the needs of service providers to utilize measures that meet their unique programmatic and community contexts.

Adolescent↗
PubMed2006

Diagnosed diabetes among American Indians and Alaska Natives aged <35 years--United States, 1994-2004.

Diabetes disproportionately affects American Indians/Alaska Natives (AI/ANs), and the prevalence of diabetes is increasing among young persons in certain AI/AN populations. To examine trends in the prevalence of diagnosed diabetes among AI/ANs aged <35 years, CDC analyzed patient data collected by the Indian Health Service (IHS) during 1994-2004. This report summarizes the results of that analysis, which indicated that the age-adjusted prevalence of diagnosed diabetes increased from 8.5 to 17.1 per 1,000 population among AI/ANs aged <35 years who use IHS health-care services. Because young persons with diabetes have more years of disease and greater risk for costly and disabling complications early in life, diabetes prevention programs targeting younger age groups have become increasingly important in AI/AN communities.

Adolescent↗